Pneumology - Original Articles Open access

Prevalence and clinical correlates of chronic pulmonary aspergillosis among symptomatic post-tuberculosis patients at a tertiary hospital in Eastern India

Authors

Published
9 November 2026
Issue
Early Access
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2026.3812

Abstract

Chronic pulmonary aspergillosis (CPA) is an underrecognized but significant sequela of pulmonary tuberculosis (TB), and data from India remain limited. In this single-center, cross-sectional study from eastern India, we evaluated 280 post-TB patients with residual radiological abnormalities to estimate CPA prevalence and identify associated clinical, radiological, and biochemical features. After excluding patients with active TB, interstitial lung disease, malignancy, or prior antifungal therapy, all participants underwent clinical assessment, spirometry, high-resolution computed tomography, Aspergillus-specific serology, and bronchoalveolar lavage when indicated. CPA was diagnosed in 27.5% of patients, with chronic cavitary pulmonary aspergillosis being the most common subtype. Multivariable analysis showed that low body mass index, the presence of aspergilloma, and elevated C-reactive protein were independently associated with CPA, while Aspergillus-specific IgG was positive in 92.2% of cases. These findings highlight the high burden of CPA among post-TB patients in India and underscore the need for greater clinician awareness and standardized screening to ensure timely diagnosis and management.

Keywords

Ethics Approval

The study was approved by the Institutional Ethics Committee (AIIMS/Pat/IEC/PGTh/July 21/05).

References

  1. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016;47:45-68.
  2. Agarwal R, Denning DW, Chakrabarti A. Estimation of the burden of chronic and allergic pulmonary aspergillosis in India. PLoS One 2014;9:e114745.
  3. Beardsley J, Denning DW, Chau NV, et al. Estimating the burden of fungal disease in Vietnam. Mycoses 2015;58:101-6.
  4. Singla R, Singhal R, Rathore R, et al. Risk factors for chronic pulmonary aspergillosis in post-TB patients. Int j Tuberc Lung Dis 2021;25:324-6.
  5. Soundappan K, Sehgal IS, Prabhakar N, et al. Incidence and prevalence of chronic pulmonary aspergillosis in patients with post‐tuberculosis lung abnormality: Results from a community survey in North India. Mycoses 2024;67:e13711.
  6. Bongomin F. Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. PLoS Pathog 2020;16:e1008742.
  7. Agarwal R, Sehgal IS, Muthu V, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J 2024;63:2400061.
  8. Chhabra SK, Kumar R, Gupta U, et al. Prediction equations for spirometry in adults from northern India. Indian J Chest Dis Allied Sci 2014;56:221-9.
  9. Gaddey HL, Holder K. Unintentional weight loss in older adults. Am Fam Physician 2014;89:718-22.
  10. Sehgal IS, Choudhary H, Dhooria S, et al. Diagnostic cut-off of Aspergillus fumigatus-specific IgG in the diagnosis of chronic pulmonary aspergillosis. Mycoses 2018;61:770-6.
  11. Hedayati MT, Azimi Y, Droudinia A, et al. Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran. Eur J Clin Microbiol Infect Dis 2015;34:1759-65.
  12. Sehgal IS, Dhooria S, Choudhary H, et al. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 2019;57:e01821-18.
  13. Ajayababu A, Meena VP, Sethi P, et al. Allergic bronchopulmonary aspergillosis in patients with prior pulmonary tuberculosis: a study on the burden, clinic-radiological features, treatment outcomes and comparison with chronic pulmonary aspergillosis and post-tubercular lung disease patients. Mycoses 2025;68:e70034.
  14. Sehgal IS, Soundappan K, Agarwal R, et al. Prevalence of chronic pulmonary aspergillosis in patients with mycobacterial and non-mycobacterial tuberculosis infection of the lung: a systematic review and meta-analysis. Mycoses 2025;68:e70060.
  15. Madden A, Ofori SK, Budu M, et al. A systematic review of chronic pulmonary aspergillosis among patients treated for pulmonary tuberculosis. Clin Infect Dis 2025;81:e163-71.
  16. Nguyen NTB, Le Ngoc H, Nguyen NV, et al. Chronic pulmonary aspergillosis situation among post tuberculosis patients in Vietnam: an observational study. J Fungi 2021;7:532.
  17. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 2011;89:864-72.
  18. Denning DW, Cole DC, Ray A. New estimation of the prevalence of chronic pulmonary aspergillosis (CPA) related to pulmonary TB – a revised burden for India. IJID Regions 2023;6:7-14.
  19. Denning DW, Riniotis K, Dobrashian R, Sambatakou H. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 2003;37:S265-80.
  20. Oladele RO, Irurhe NK, Foden P, et al. Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis 2017;21:1056-61.
  21. Iqbal N, Irfan M, Mushtaq A, Jabeen K. Underlying conditions and clinical spectrum of chronic pulmonary aspergillosis (CPA): an experience from a tertiary care hospital in Karachi, Pakistan. J Fungi 2020;6:41.
  22. Page ID, Byanyima R, Hosmane S, et al. Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J 2019;53:1801184.
  23. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev 2011;20:156-74.
  24. Page ID, Richardson M, Denning DW. Antibody testing in aspergillosis--quo vadis? Med Mycol 2015;53:417-39.
  25. Schweer KE, Bangard C, Hekmat K, Cornely OA. Chronic pulmonary aspergillosis. Mycoses 2014;57:257-70.
  26. Kurhade AM, Deshmukh JM, Fule RP, et al. Mycological and serological study of pulmonary aspergillosis in central India. Indian J Med Microbiol 2002;20:141-4.
  27. Shahid M, Malik A, Bhargava R. Prevalence of aspergillosis in chronic lung diseases. Indian J Med Microbiol 2001;19:201-5.

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